From left, St. Louis Alderman Megan Green, former state Rep. Stacey Newman, St. Louis County Councilwoman Lisa Clancy and St. Louis Alderman Christine Ingrassia join a rally outside Planned Parenthood.

File photo|Carolina Hidalgo | St. Louis Public Radio

As the deadline nears for the state’s decision on whether to renew the license for Missouri’s last remaining abortion clinic, doctors at Planned Parenthood have announced they have stopped following a state rule that, in effect, makes them conduct two pelvic exams before providing the procedure.

The St. Louis clinic had started conducting the exams several weeks ago as part of a corrective plan between the organization and the Missouri Department of Health and Senior Services. The plan was put in place after the agency found Planned Parenthood wasn’t in compliance with state rules, which include an initial pelvic exam as part of its 72-hour consent law.

But this week, physicians said they had stopped doing the first exam, which they deem invasive, medically unnecessary and traumatic for patients and doctors.

“Unfortunately, and not unpredictably, we saw firsthand the real trauma that it was causing for our patients,” said Dr. Colleen McNicholas, a physician at the clinic. “So now we’ve decided that’s just not something we can do.”

She called the pelvic exam “one more hoop” the state is making the clinic jump through in an effort to curb abortion access in the state.

A DHSS spokeswoman declined to comment Thursday on the clinic’s decision to perform only one pelvic exam.

Laws requiring pelvic exams before abortions have been on the books in Missouri for decades. However, the state only this year started enforcing the additional exam during the first consultation, McNicholas said.

Deciding whether to conduct the exam was initially a difficult choice, McNicholas said. It pitted the doctors’ belief in abortion access against their medical beliefs.

“Having spent a few weeks doing that, we really felt like we had been pushed to a point where the medical ethics of the care we were providing were being pushed and crossed over a line,” McNicholas said.

State regulators disagree the exam is medically unnecessary. Examining a patient before the day of the procedure makes sense, said Dr. Randall Williams, director of the Department of Health and Senior Services, earlier this month.

“To examine the patient before you decide to operate is the standard of care that doctors provide all over the country,” Williams, who is an OB-GYN, told reporters.

Doctors have historically used pelvic exams to determine any pre-existing medical conditions and risks to the patient as well as to determine the duration of the pregnancy and the preferred abortion method.

However, McNicholas said, physicians can now use modern, less invasive technology to examine a patient. And while a pelvic exam immediately before a procedure is necessary to ensure safety, one so far before an abortion doesn’t offer doctors any helpful information, McNicholas said.

The announcement came just days before the health department is scheduled to make a decision on whether to renew the clinic’s license.

That license renewal is the subject of a high-profile court case between the state and the clinic. Planned Parenthood sued the state health department after it didn’t act on the clinic’s annual license renewal.

Abortion clinics in Missouri are required to undergo an annual inspection to keep their license. During the initial inspection earlier this year, the state found the clinic wasn’t complying with the rule that mandated the first pelvic exam, among other issues. The clinic then issued a correction plan in which they said they would start to conduct the exams.

After that, department officials said they needed to interview physicians who worked at the clinic about instances of care they said compromised patient safety. The state says the clinic has performed some abortions improperly, resulting in failed procedures.

Some physicians refused to be interviewed, citing confidentiality and other concerns, and the state then said it couldn’t sign off on the renewed license.

Planned Parenthood representatives accused the state of conducting a vague investigation that was a misuse of the state’s regulatory power. In the lawsuit, the organization asked Judge Michael Stelzer to bar the state from using the interviews as part of the license-renewal process and to declare DHSS’s investigation unlawful.

A preliminary injunction is keeping the St. Louis clinic’s license in place until the judge makes a more permanent decision. As part of that injunction ruling, Stelzer said the state needed to make a decision to renew or reject the license by Friday, when a status hearing is scheduled.

Instead of persuading the clinic to walk the line drawn by state regulators, the legal battle has spurred Planned Parenthood to buck the regulation, McNicholas said.

“We’ve seen in this process, the department of health can do literally anything they want and ask us to do anything they want,” she said. “In that setting, the only real recourse we have is to do the right thing for the patient.”

Clarification: An earlier version of this story misstated state requirements on pelvic exams. State law requires doctors to perform only one pelvic exam on patients seeking an abortion. Planned Parenthood officials have said that a previously required pelvic exam 72 hours before an abortion in effect compelled doctors to perform two such exams as one was medically needed immediately before the procedure. State health officials dropped the 72-hour pelvic exam requirement last week.

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